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General NPI Number Information
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NPI Number | 1104062843
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Entity Type | Organization
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Legal Business Name | EUGENE A. TYNES D.D.S. P.C.
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Dates
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Enumeration Date | 12/31/2008
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Last Update Date | 12/31/2008
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Provider Practice Location Address
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Address Line | 300 PARK DR S STE 202
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City | GREAT FALLS
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State | MT
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Zip | 59405-1819
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Country | US
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Telephone | 406-761-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PARK DR S STE 202
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City | GREAT FALLS
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State | MT
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Zip | 59405-1819
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Country | US
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Telephone | 406-761-3800
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EUGENE A TYNES
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Credential | DDS
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Telephone | 406-761-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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